Culture affects communication of trauma, coping, help-seeking, and expectations of treatment, as well as the way people make sense of post-traumatic distress. Expressions of symptoms of post-traumatic stress vary according to cultural and contextual factors. In this chapter, we discuss cross-cultural communication in clinical settings with patients from an immigrant or refugee background, as well as symptoms of post-traumatic stress. Cultural aspects of communication related to language, idioms of distress, discourse systems, help-seeking, and identification of signs of trauma and assessment and treatment will be considered. Barriers to communication and support in overcoming barriers in cross-cultural communication will be discussed. Consideration will also be given to how to create a trusting relationship and therapeutic alliance. Theoretical aspects will be presented, together with a case illustrating communication and interaction with health care.